Dr. Harry Rakowski - Friday -POSTMEDIA
The World Health Organization on July 23 declared monkeypox a public health emergency of international concern. How dangerous is it and what do we need to do to understand its spread and how best to contain it?
© Provided by National PostFILE PHOTO: Test tubes labelled
The U.S. Center for Disease Control website informs us that the monkeypox virus is part of the family of variola viruses which also cause smallpox, the latter being a much more serious disease. Monkeypox got its name in 1958 when an outbreak of pox like disease occurred in Africa in research monkeys. The disease appears to be misnamed since it is likely spread by rodents rather than monkeys; however the name stuck.
Monkeypox began appearing in Africa in about 1990 as smallpox vaccines were phased out when the condition was almost eradicated. Vaccination was also curtailed then over concern about side effects of the older vaccine then available. It is hoped that those who received smallpox vaccination when young have retained some cross immunity to monkeypox, but this is not yet clear.
While monkeypox was endemic to Africa at a low level of disease, it was initially reported in Europe in mid-May with outbreaks in at least three countries linked to large events with gay men having sex with multiple partners, according to global a study published in the New England Journal of Medicine. The CDC website on July 28 reported 21,000 cases in 76 countries, most who had never before seen a case. Cases are now rising globally by about 1,000 per day and this is likely an underestimate of true disease burden due to underreporting. About 99 per cent of cases are occurring in men who typically acknowledge having sex with other men. In Canada the first case was reported July 1 and reached 745 cases by July 28.
Monkeypox is spread by close physical contact with an infected person through sexual activity, mucous membrane transfer or contact with infected fabrics such as clothes or bedsheets. It is also possibly spread by droplets but this is not as certain. It needs to be understood that is not only a sexually transmitted disease. It can infect all individuals at any age by skin contact with infected people or items to which the virus transferred. It is not clear how long the virus remains viable on fabrics or surfaces.
After exposure, about 1-2 weeks later, the infected person may develop fever with flu like symptoms including headache, muscle aches and swollen lymph nodes. Typically a pox like rash develops a few days after the onset of fever, characterized by pus filled bumps (pustules) that can look like pimples or blisters.
While the disease is mainly highly uncomfortable with few deaths, risks are higher for young children, pregnant women and older people. Most concerning is that it represents a growing public health crisis during a time of already constrained health care resources.
Two vaccines approved by the FDA can be used to prevent monkeypox infection. The older ACAM vaccine, of which there is large supply, was developed for smallpox. Unfortunately while readily available, it has significant side effects, with about a 1/1000 chance of a serious side effect. As such, it is is unsuitable for people with HIV, common among the men infected with monkeypox in the global study, and is not suggested for those with other immune diseases, eczema, or heart disease.
The World Health Organization on July 23 declared monkeypox a public health emergency of international concern. How dangerous is it and what do we need to do to understand its spread and how best to contain it?
© Provided by National PostFILE PHOTO: Test tubes labelled
The U.S. Center for Disease Control website informs us that the monkeypox virus is part of the family of variola viruses which also cause smallpox, the latter being a much more serious disease. Monkeypox got its name in 1958 when an outbreak of pox like disease occurred in Africa in research monkeys. The disease appears to be misnamed since it is likely spread by rodents rather than monkeys; however the name stuck.
Monkeypox began appearing in Africa in about 1990 as smallpox vaccines were phased out when the condition was almost eradicated. Vaccination was also curtailed then over concern about side effects of the older vaccine then available. It is hoped that those who received smallpox vaccination when young have retained some cross immunity to monkeypox, but this is not yet clear.
While monkeypox was endemic to Africa at a low level of disease, it was initially reported in Europe in mid-May with outbreaks in at least three countries linked to large events with gay men having sex with multiple partners, according to global a study published in the New England Journal of Medicine. The CDC website on July 28 reported 21,000 cases in 76 countries, most who had never before seen a case. Cases are now rising globally by about 1,000 per day and this is likely an underestimate of true disease burden due to underreporting. About 99 per cent of cases are occurring in men who typically acknowledge having sex with other men. In Canada the first case was reported July 1 and reached 745 cases by July 28.
Monkeypox is spread by close physical contact with an infected person through sexual activity, mucous membrane transfer or contact with infected fabrics such as clothes or bedsheets. It is also possibly spread by droplets but this is not as certain. It needs to be understood that is not only a sexually transmitted disease. It can infect all individuals at any age by skin contact with infected people or items to which the virus transferred. It is not clear how long the virus remains viable on fabrics or surfaces.
After exposure, about 1-2 weeks later, the infected person may develop fever with flu like symptoms including headache, muscle aches and swollen lymph nodes. Typically a pox like rash develops a few days after the onset of fever, characterized by pus filled bumps (pustules) that can look like pimples or blisters.
While the disease is mainly highly uncomfortable with few deaths, risks are higher for young children, pregnant women and older people. Most concerning is that it represents a growing public health crisis during a time of already constrained health care resources.
Two vaccines approved by the FDA can be used to prevent monkeypox infection. The older ACAM vaccine, of which there is large supply, was developed for smallpox. Unfortunately while readily available, it has significant side effects, with about a 1/1000 chance of a serious side effect. As such, it is is unsuitable for people with HIV, common among the men infected with monkeypox in the global study, and is not suggested for those with other immune diseases, eczema, or heart disease.
Related video: Monkeypox declared global health emergency by WHO, as 2022 case count his 16k (Global News) Duration 2:07 View on Watch
The newer JYNNEOS (Imvanex in Europe) vaccine was developed over concerns that certain countries might weaponize smallpox and that a future antidote treatment might be necessary. Only small numbers of supplies were stored in both the U.S. and Canadian strategic vaccine stockpiles. There is only one producer of this vaccine, Danish company Bavarian Nordic. There is some controversy that the Europeans approved the ramped up production as the crisis evolved, while the American FDA lagged many months behind and only recently gave production approval for the plant producing the vaccine, thus delaying availability.
The company reports that the U.S. is receiving two million new doses this year, with an additional five million going to other countries.
Canada has signed a $56 million contract with Bavarian Nordic with deliveries starting in 2023. While this is the preferred and safer vaccine there may be short supply until next year. Canada has delivered shots to about 5,000 high risk people to date. No disclosure has been made yet as to how much vaccine will be available for the remainder of the year and whether if supplies are inadequate, the older ACAM vaccine may need to be used.
While ideally two vaccine doses given 28 days apart are recommended, a strategy being considered is to give more people only the first shot, since this may provide protection for more than one year.
Priority for vaccination is men with multiple male sexual partners and those people exposed to an infected person. If cases explode we will have a critical vaccine shortage until next year.
Public health measures remain very important. Venues that plan events with high levels of sexual activity have to date declined to cancel them and this should be rethought. People need to take personal responsibility for their actions. Those people exposed need to isolate and be tested for disease confirmation if a rash breaks out. Fortunately few people have required hospitalization, however most infected to date are healthy men and this may change as older people contract the disease.
We need to take the risk of monkeypox seriously and not stigmatize communities where it is most prevalent. Those at highest risk need to get vaccinated and avoid sexual contact with multiple partners. There are lessons to be learned about the spread of HIV which was initially thought to be a disease of gay men and then spread widely beyond this population.
Monkeypox is not HIV infection and won’t have its consequences. It is self limiting, and once infected, antibodies produced will likely prevent re-infection.
It is not nearly as great a risk as COVID-19 with an ever mutating virus that escapes the constraint of vaccination and has infected over 1 billion people.
It is however, yet another serious worldwide health concern that can further disrupt lives, the ability to work and further stress our crumbling health-care system. We have done too little too late to greatly dampen spread. We now need to urgently vaccinate as many at risk individuals as possible, act responsibly to avoid exposure, increase our testing capacity and pray that the disease burden will be manageable for our already overwhelmed health-care system.
Dr. Harry Rakowski is an academic Toronto cardiologist and commentator.
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